But they also face a man-made threat, operators say — below-cost reimbursements from Medicare and Medicaid on bills that run into the tens of thousands of dollars.

“The reimbursements that we receive are far below our costs for the majority of the patients that we transport,” said Jeff Bartkoski, president of the nonprofit Mercy Flight Central, which operates out of Canandaigua, Marcellus and Griffiss International Airport in Rome. “To some extent, it’s true of our health care system across the board.”

The problem is not just local. A national campaign known as Save Our Air Medical Resources, or S.O.A.R., launched earlier this month to campaign for better reimbursement rates, through proposed federal legislation and state activism.